A strike by doctors hit OPD services in private hospitals across the country on January 2, forcing the government to announce in Parliament that afternoon that a proposed law to replace India’s existing medical education regulator with a new body had been sent to the Parliamentary Standing Committee for Health and Family Welfare for review. This is the second time that the Committee will take up a Bill to repeal the Indian Medical Council Act, 1956, the law under which the pre-Independence Medical Council of India (MCI) was reconstituted.
What is the National Medical Commission (or NMC) Bill, 2017?
The Bill, introduced in Lok Sabha by Health Minister J P Nadda on December 29 last year, provides for the replacement of the MCI — which is elected by medical practitioners across the country — with a 25-member National Medical Commission selected by a search committee headed by the cabinet secretary. The chairperson and members of the NMC will have terms of four years each. A National Licentiate Examination for MBBS graduates will be introduced within three years of the Bill’s passage by Parliament. The exam will serve as the basis for granting licences for medical practice, and for admission to postgraduate courses.
A Medical Advisory Council constituted by the central government will advise and make recommendations to the NMC. The Council will include a member from each state and Union Territory, chairperson of the University Grants Commission (UGC), and director of the National Accreditation and Assessment Council, the country’s regulator of higher education institutions.
Four autonomous Boards — appointed by the Centre and consisting of a president and two members — will work under the supervision of the NMC: an Under-Graduate and a Post-Graduate Medical Education Board, a Medical Assessment and Rating Board, and an Ethics and Medical Registration Board. This structure is in line with the recommendations of the expert committee led by the late Prof Ranjit Roy Chaudhury, set up by the union Health Ministry in July 2014 to study the norms for the establishment of medical colleges.
The NMC Bill also allows practitioners of homoeopathy and Indian systems of medicine to prescribe allopathic medicine upon completion of a “bridge” course. The Bill marks a radical change in regulatory philosophy — in the NMC regime, medical colleges will need permission only once for establishment and recognition, with no need for annual renewal. Colleges can increase the number of seats on their own, subject to the current cap of 250. They can also start postgraduate courses on their own.
However, fines for violation are steep — 1.5 times to 10 times the total annual fees charged.
But why does the Medical Council of India need to be replaced?
In its 92nd report (submitted in March 2016), the Parliamentary Standing Committee for Health and Family Welfare examined MCI’s functioning, and identified problems such as the failure to produce doctors, including specialists and super specialists; shortage of teachers in medical colleges; poor regulation of undergraduate and postgraduate medical education; opacity and alleged corruption in the functioning of the regulator and its lack of accountability and failure to discharge mandated responsibilities; and the prevalence of capitation fees in private medical colleges in violation of the law. The Committee observed that “currently the MCI is an exclusive club of medical doctors as the IMC Act does not call for diversity of backgrounds in the members” and that “across the world, a perspective has gained ground that self-regulation alone does not work because medical associations have fiercely protected their turf and any group consisting entirely of members from the same profession is unlikely to promote and protect public interest over and above their own self-interest”. There was a need for “check-and-balance mechanisms”, the Committee said, apart from “inputs from people with excellence and competence in other disciplines”.
So, why are doctors against this proposed new law and body?
The Indian Medical Association (IMA), the organisation of “doctors of modern scientific system of medicine”, has been vocal in its objections to the composition of the proposed NMC and various bodies under it, whose members are mostly nominated, not elected. The IMA, whose stated goal is to “look after the interest of doctors as well as the well-being of the community at large”, is also upset at the lifting of the ban on foreign citizens practising in India.
According to the IMA, the licentiate examination will create additional hurdles for the backward communities. “The NMC will ‘cripple’ the functioning of the medical profession by making it completely answerable to the bureaucracy and non-medical administrators,” the IMA said in a statement issued in the last week of December. “Devoid of federal character, this non-representative half-non-medical body will… not represent the medical profession of India in any manner. Delivering affordable healthcare… presents enormous challenges and opportunities for the medical fraternity. Political ideologies play a distinctive role in determining… health policies. The profession is fighting to ensure that further escalation of healthcare costs can be avoided.”
A major sticking point in the Bill is the prospect of “cross-pathy” — a person trained in one stream of medicine practising another — which is specifically disallowed under the current rules. AYUSH practitioners who are required to pass the bridge course to prescribe allopathic medicines do not have to pass the licentiate examination either.
But what is the case for doing away with the system of elections?
The Standing Committee Report said: “The possibility of use of money in elections gives advantage to private management-sponsored candidates getting over-represented. Since the number of private medical colleges is increasing, the over-representation of private medical college representatives would affect the role and responsibilities of the MCI as there is a possibility of dilution of standards.”
The Ranjit Roy Chaudhury Committee had said: “In keeping with global standards, and as is the practice in other educational fields in our country (AICTE and UGC), regulatory structure should be run by persons selected through a transparent mechanism rather than by the current process of election and nominations. Of course, keeping in mind the federal nature of the country, adequate provision must be made for the representatives of the states to participate in the regulatory processes.”
How have earlier attempts to overhaul the regulation of medical education fared?
On December 22, 2011, the UPA government introduced The National Commission for Human Resources for Health Bill, 2011, to replace The Indian Nursing Council Act, 1947, The Pharmacy Act, 1948, The Dentists Act, 1948, and The Indian Medical Council Act, 1956, and overhaul the structure of medical education regulation. The Bill was referred to the Standing Committee, which, in its 60th Report tabled in Parliament in 2012, found it wanting with regard to the participation of states in the proposed regulatory structure, the vision for the regulation of AYUSH education, the regulation of paramedical fields such as physiotherapy. “The Committee recommends that the (Health) Ministry may withdraw this Bill and bring forward a fresh Bill after sufficiently addressing all the views, suggestions and the concerns expressed. Before finalising the fresh Bill, the Ministry may hold discussions with all the stakeholders including the State Governments,” the Report said.